A rare differential for non-accidental injury
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A rare differential for non-accidental injury

Heather McMillan Avanced paediatric nurse practitioner, The Mid Yorkshire Hospitals NHS Trust, on behalf of the RCN’s Research in Child Health community

Non-accidental injury (NAI) is a common differential diagnosis in children presenting with unexplained fractures. Multi-agency investigations and strategy meetings are completed at hospital, and although necessary, can create anxiety and stress for the family. Differentials such as osteogenesis imperfecta and rare neuropathies are additional possibilities


This case study presents a two year old admitted via the emergency department (ED) with right tibia and fibula fractures. Additional concerns included marked tenderness and calf swelling with no mechanism of injury witnessed by either parent. Discussions with consultant radiologists specialising in children’s safeguarding suggested significant force from a direct anterior or posterior blow would have been required.

Nursing Children and Young People. 29, 10, 22-22. doi: 10.7748/ncyp.29.10.22.s27